Development of a simple screening tool for opportunistic COPD case finding in primary care in Latin America: The PUMA study

Abstract

Background and objective: Opportunistic chronic obstructive pulmonary disease (COPD) case finding approaches for high-risk individuals with or without symptoms is a feasible option for disease identification. PUMA is an opportunistic case finding study conducted in primary care setting of Argentina, Colombia, Venezuela and Uruguay. The objectives were to measure COPD prevalence in an at-risk population visiting primary care for any reason, to assess the yield of this opportunistic approach and the accuracy of a score developed to detect COPD. Methods: Subjects attending routine primary care visits, ≥40 years of age, current or former smokers or exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) < 0.70 and the lower limit of normal of FEV 1 /FVC. Results: A total of 1743 subjects completed the interview; 1540 performed acceptable spirometry. COPD prevalence was 20.1% (n = 309; ranging from 11.0% in Venezuela to 29.6% in Argentina) when defined using post-BD FEV 1 /FVC < 0.70, and 14.7% (n = 226; ranging from 8.3% in Venezuela to 21.8% in Colombia) using the lower limit of normal. Logistic regression analysis for both definitions showed that the risk of COPD was significantly higher for persons >50 years, heavy smokers (>30 pack-years), with dyspnoea, and having prior spirometry. A simple score and a weighted score constructed using the following predictive factors: gender, age, pack-years smoking, dyspnoea, sputum, cough and spirometry, had a mean accuracy for detecting COPD (post-BD FEV 1 /FVC < 0.70) of 76% and 79% for the simple and weighted scores, respectively. Conclusion: This simple seven-item score is an accurate screening tool to select subjects for spirometry in primary care.

Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study

“…Participation rates in the PUMA study have been published elsewhere 24–27. Among the 1,743 patients who completed interviews, 1,540 had acceptable spirometry values.…”

“…Complete details of the methodology have been published previously 24–27. In summary, this was a multicenter, multinational, cross-sectional, and non-interventional study.…”

“…Recently, the P revalence St U dy and Regular Practice, Diagnosis and Treat M ent, Among General Practitioners in Populations at Risk of COPD in Latin America (PUMA) study, conducted in the primary care setting, evaluated the prevalence of airflow limitation in a population at risk for COPD 24,25. This study provides a good opportunity to assess different aspects of airway limitation diseases in a large international primary care sample from Latin America.…”

Year in review 2016: Chronic obstructive pulmonary disease and asthma

“…In a multinational study from South America, López Varela et al . evaluated a simple screening index for COPD based on symptoms and risk factors which might facilitate early diagnosis . The problem of differentiating asthma from COPD is now well recognized and reflected in the emerging research on the putative asthma–COPD overlap syndrome (ACOS).…”

What factors influence an early COPD diagnosis in primary care?

“…Therefore, questions arise regarding screening itself. The current practice is active case-finding, not screening (GOLD, 2017), as case-finding in primary care is a practicable option in terms of resources for early COPD detection (López Varela, 2016). But is this method responsible for the 'missing millions'?…”